The outcome of care in people with type 1 diabetes after switching to insulin glargine-based regimens in a real-life setting: a long-term observational study

Background: Different insulin preparations are used as basal insulins in type 1 diabetes. The aim of this study was to assess long-term efficacy and safety of insulin glargine after switching from other basal insulins in type 1 diabetes in a real-life setting. Methods: In the clinic's database, 87 subjects treated with glargine for > 1 year were identified. In all patients, HbA(1c) level, insulin doses, episodes of severe hypoglycaemia, diabetic complications, comorbidities, body mass index (BMI), blood pressure and concomitant medications' use were monitored throughout the entire follow-up period. Results: During observation, lasting mean 61.9 +/- 27.6 months HbA(1c) level decreased from 8.86 +/- 1.60% (73.3 mmol/mol) to 8.25 +/- 1.40% (66.7 mmol/mol), p < 0.001. This improvement was maintained up to 8 years. Frequency of severe hypoglycaemia was 6.24/100 patient-years. Total insulin requirement did not changed significantly. BMI increased from 23.57 +/- 2.90 to 24.52 +/- 3.46 kg/m(2) (p < 0.001). Significant weight gain (> 5%) occurred in 30 subjects, while 10 patients lost weight. Mean systolic blood pressure (SBP) increased from 136.3 +/- 13.4 to 140.7 +/- 15.1 mmHg (p = 0.008), while diastolic blood pressure remained unchanged. Development or progression of diabetic complications was revealed in 11 subjects. Conclusions: Following switch from other basal insulins to insulin glargine in type 1 diabetic patients, glycaemic control significantly improved, with unchanged total insulin requirement and with low risk of severe hypoglycaemia. Weight gain and elevation of SBP observed in this study require special attention and educational efforts. In summary, insulin glargine can be recommended as an effective and safe basal insulin in type 1 diabetes in a real-life setting.